Provider Demographics
NPI:1770535304
Name:BROSKA, PAMELA (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BROSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 894830
Mailing Address - Street 2:LOCK BOX 4830
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4830
Mailing Address - Country:US
Mailing Address - Phone:760-969-5900
Mailing Address - Fax:760-969-5911
Practice Address - Street 1:72785 FRANK SINATRA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3205
Practice Address - Country:US
Practice Address - Phone:760-969-5900
Practice Address - Fax:760-969-5900
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61351207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G613512OtherINDIVIDUAL PTAN
CA070013862OtherRAILROAD MEDICARE
CAA53641Medicare UPIN
CAWGA61351IMedicare PIN
CA070013862OtherRAILROAD MEDICARE
CAWGA61351JMedicare PIN
CA00G613515Medicare PIN
CAWG61351HMedicare PIN
CA00G613512OtherINDIVIDUAL PTAN
CAWG61351KMedicare PIN
CA00G613517Medicare PIN
CA00G613516Medicare PIN